Do you love the clinical side of oncology and want to play a critical part in maintaining the integrity of our operations? Do you value being an essential collaborative partner to ensure cancer patients receive the best treatments? We want you to be a part of our team!
OncoHealth is a leading digital health company dedicated to helping health plans, employers, providers, patients, and life science researchers navigate the physical, mental, and financial complexities of cancer through technology enabled services and real-world data analytics. Through an evidence-based, real-world analytics approach to utilization management, OncoHealth's prior authorization platform is used by health plans and their network physicians to support 7 million health plan members in the US and Puerto Rico.
About the Role
The Case Review Specialist ensures that case documentation is provided by the provider for accurate and timely determinations and communicates with clinical and non-clinical staff to facilitate case discussions.
- You will obtain and maintain clinical records and transmit timely determinations to the provider and payer
- Contact provider and request medical records as needed
- Process protocols according to client contract turnaround times
- Work collaboratively with clinical and non-clinical staff to facilitate case discussions
- Provide clinical staff all necessary records and assist the clinical team with Peer to Peer calls to providers
- Fax intake, labeling, and preparing and mailing letters as needed
- A people person looking to make a difference in the lives of oncology patients
- Must have 2-4 years' administrative and/or customer service experience
- Demonstrated working knowledge of medical terminology and coding. These elements are important to our business!
- Experience reviewing medical documentation and/or medical coding in a pharmacy, medical office or hospital preferred
- Excellent organizational skills, high-level professionalism and confidentiality, and a heart for client services
- Bachelor’s degree always helps
- Must have flexibility with their schedule! Must be flexible to cover or change shifts to meet operational needs M-F between the hours of 8:30am - 10pm EST (with Saturdays remaining the same, 8:30am - 6pm EST)
About the Location
We are open to remote employees, but majority of your team members are located in South Florida!
Taking ownership of quick action, critically thinking through the needs, and working well with others are key competencies of team member success. Our leadership is dedicated to building a culture based on respect, clinical excellence, innovation – all with a focused mission of putting patients first!
We offer a full benefit package starting on your first day, along with a company bonus and equity so you can experience the value of our growth along with the rest of the team. You will work from (or visit) our very modern and engaging offices, and experience a fun, collaborative environment where social activities and community events matter. We enjoy being together!
The cost of cancer related medical services and prescription drugs in the United States is expected to reach $246 billion by 2030. OncoHealth has enjoyed rapid growth over the past 3 years and seeks smart, collaborative people to join its team. We have just under 200 team members, so we can move swiftly but precisely to the market needs of our customers. Strongly backed financially by leading healthcare equity partners, we remain in an investment mode. This means we are open-minded to how we get the work done – now is the perfect time to talk to us!
Our Current Solutions
Through the use of OncoHealth's utilization management system, OneUM, our customers can use a single e-Prior Authorization portal for all oncology drug request and treatments. Our system improves quality of care, reduces provider abrasion and gives health plans visibility into the total cost of oncology treatment.
OncoHealth offers Oncology Insights Pro, an analytic software solution that enables health plans to use data and analytics to improve oncology programs. Using real world data, our engineers normalize data to create analytic dashboards with drill down compatibilities. The data is the paired with expert guidance providing the strategies an insight needed to keep up with the continuing evolving cancer treatment landscape.
OncoHealth offers Pharmacy Consulting services to health plans and pharmaceutical companies. New cancer treatments are entering the market at an unrelenting pace. Since 2018, the FDA approved 121 new cancer applications including 49 novel cancer drug entities. Our Board-Certified Oncology Pharmacologists can help health plans update drug policies, offer utilization management and formulary advice, and development training for staff.